SECRETARY OF EDUCATION IN THE STATE

UNDERSECRETARIAT OF STATE EDUCATION

DIRECTORATE OF SECONDARY EDUCATION
Higher Institute of Nursing Studies in the State of Chiapas

QUESTIONNAIRE FOR NURSING STAFF OF SECOND LEVEL INSTITUTIONS

HEALTH CARE.

Health institution: _____________________________________________________

_______________________________

Answer the following questionnaire by marking with an X the option that answers the question.
according to your criteria.

What level of profession does he/she have?

General Nurse Bachelor's Degree in Nursing Specialist Nurse

2. How long have you been working at this institution?

From 1 to 5 years From 6 to 10 years From 11 to 15 years More than 11 years

3. Do you maintain a good relationship with your coworkers?

If No

4. Do you maintain good communication with your patients?

If No

Does your personal life influence your work life?

Yes No

6. Do you know the internal regulations of the institution?

If No

7. Do you consume food within the service where you work?

Yes No

8. Do you wear jewelry during your workday?

Yes No

Does she usually keep her nails long?

If No

9. Do you know the correct handwashing technique?

Yes No

10. Do you wash your hands before starting your workday and before each procedure?
 Yes No Sometimes

11. Do you know the nursing ethics decalog?

Yes No

12. Do you know what the quality indicators are?

Yes No

13. How often do you feel stressed at your job?

Always Regularly Never

14. Can you identify the cause of your work-related stress?

Yes No

15. Do you know how to use the RPBI deposits?

If No
16. Does the institution provide training on the RPBI?

If No

17. How often is an IV drip changed?

24 hours 48 hours 72 hours

18. How many times do you attend clinical sessions (per month)?

1 time More than 3 times More than 6 times

19. Do you believe that the relationship between nursing staff influences patient recovery?

Yes No
 SECRETARY OF EDUCATION IN THE STATE
UNDERSECRETARIAT OF STATE EDUCATION
DIRECTORATE OF SECONDARY EDUCATION
Higher Institute of Nursing Studies in the State of Chiapas

QUESTIONNAIRE ADDRESSED TO PATIENTS RECEIVING CARE FROM THE

NURSES IN SECOND LEVEL INSTITUTIONS.

Health institution: _____________________________________________________

________________________

Complete the following questionnaire by marking with an X the option that answers the question.
according to your judgment.

Does the nurse come to you during the shift change?

Always Sometimes Never

At the beginning of the shift, does the nurse conduct a preliminary assessment of their health status?

Always

3. When the nurse addresses you, does she call you by your name?

Yes No
4. Is the nurse in charge of your care attentive to your needs?

Yes No
5. The treatment provided by the nursing staff is:

Good Regular Bad

6. Do you know the rights you have within the institution?

Yes No

7. Do you think that socioeconomic level influences the care provided?

Yes No
8. At the time of administering your medications, the nurse informs you about what you
is managing:
 Yes No Sometimes

9. In the implementation of nursing procedures or techniques, do you receive a prior explanation?

Yes No

10. Do you receive information about visiting hours?

Yes No

11. Do you think that the vocabulary used by nursing staff is appropriate?

If No
12. How do you view the relationship and communication among nursing staff?

Good Regular deficient

13. Have you noticed if the nursing staff makes constant use of their cell phones during their hours of
work?

Yes No Sometimes

14. Consider whether the supplies and materials within the service you are in: are they
necessary?

If No
15. Do you receive health promotion topics from the nursing staff?

always Sometimes Never

16. The nursing staff washes their hands or uses hand gel before and after.
from contact with you or another patient

Yes No Sometimes
17. How do you consider the hygiene conditions of the service you are in?
 Good Regular Mala

18. How do you consider the procedures applied by the nursing staff?

Good Regular Bad

19. Do you believe that nurses are fully trained to practice?

profession?

If No
20. How do you perceive the personal image of the nurse in front of you:

Good Regular Mala

SECRETARY OF EDUCATION IN THE STATE

STATE EDUCATION SUBSECRETARIAT
DIRECTORATE OF SECONDARY EDUCATION
HIGHER INSTITUTE OF NURSING STUDIES IN THE STATE OF CHIAPAS

QUESTIONNAIRE ADDRESSED TO THE RELATIVES OF USERS RECEIVING CARE

FROM THE NURSES IN SECOND LEVEL INSTITUTIONS.

Health institution: _____________________________________________________

________________________

Answer the following questionnaire by marking with an X the option that answers the question.
according to your criterion.

1. How do you evaluate the treatment by the nursing staff towards your family member?

Good Bad Regular

Do you know the institution's internal regulations regarding visiting hours?

Yes No

3. Does the nurse inform you about the procedures that will be done to your family member?
 If No Sometimes

4. Have you observed if the nursing staff wears accessories (earrings, rings, bracelets among others)?
others)?

Yes No
5. Do you receive health promotion topics from nursing staff?

always Sometimes Never

6. How do you assess the hygiene conditions of the service in which your patient is located?

Good Regular Bad

7. How do you perceive the personal image of the nurse before you:

Good Regular Bad