Scribd
Upload
42 views

Arellano University College of Nursing 2600 Legarda St. Manila, Philippines WWW - Arellano.edu - PH

The document contains a demographic data form and questionnaire for a nursing professional. It requests information such as name, address, education history, employment details, reasons for career choices, and continuing education activities. The 13 questions probe the nurse's work experience, responsibilities, challenges faced, professional development, and involvement in nursing organizations.

Uploaded by

synaPtiCjeRk
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
42 views

Arellano University College of Nursing 2600 Legarda St. Manila, Philippines WWW - Arellano.edu - PH

The document contains a demographic data form and questionnaire for a nursing professional. It requests information such as name, address, education history, employment details, reasons for career choices, and continuing education activities. The 13 questions probe the nurse's work experience, responsibilities, challenges faced, professional development, and involvement in nursing organizations.

Uploaded by

synaPtiCjeRk
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

Arellano University

COLLEGE OF NURSING
2600 Legarda St. Manila, Philippines
www.arellano.edu.ph

DEMOGRAPHIC DATA:

NAME: _________________________________ GENDER: ________AGE:_____


ADDRESS: ________________________________________________
RELIGION: _____________________
NATIONALITY: ________________
DATE OF BIRTH: ___________________ PLACE OF BIRTH: ___________________
FATHER: ________________________________ OCCUPATION:
_________________
MOTHER: _______________________________ OCCUPATION: _________________
CONTACT NO._____________________________
STATUS: _________

If married,

Name of Children: Age


_________________________ _______
_________________________ _______
_________________________ _______
_________________________ _______

Name of Spouse: _________________________


Occupation: __________________________
Age: ______

EDUCATIONAL BACKGROUND:
School Year graduated
Primary __________________________________ ____________
Secondary __________________________________ ____________
Tertiary __________________________________ ____________

TOPIC: Different fields of nursing


QUESTIONS:

1. What is/are your job before the present employment?


____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

2. Why you choose this field of nursing?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

3. How long have you been working with the present field?
_____________________________________________________________________
_____________________________________________________________________

4. What are your job descriptions all about?


_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

5. What are your tasks & responsibilities?


_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. Examples of problems that you had been encountered in your practice/
profession?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

7. Why did you take up Nursing?


_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

8. Do you have any plans of going abroad?


If YES, where do you plan to go & the reason why you want to work abroad?
If NO, why did you prefer to stay in the Philippines?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

9. What can you say about the nursing program today compared during your time?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

10. Do you have any other sources of income excluding (except) your present job as a
nurse?
If YES, what is it?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
______________________________________________________

11. Do you have any title or accomplishments during collegiate year in nursing?
What is it?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

12. Are you a member of any Accredited Nursing organizations here in the
Philippines? Like for examples, ORNAP, PNA, etc.
If YES, what organization/s do you belong? And how long you have been a
member?
If NO, why don’t you have any organization?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

13. What kind of seminars or symposiums are you attending as part of your
continuing professional education (CPE)?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

__________________________________
(Signature above printed name)

___________________________________
Licensed #

Prepared by:
Christine P. Marin
BSN-II
Arellano University

You might also like