Survey Instrument

Dear Respondents:
We are graduate students of Adventist University of the Philippines. As part of our requirements we are
conducting a survey on the political astuteness of Filipino Nurses. In this regard, you have been chosen
as one of the respondents for this survey. Please supply the information as requested and kindly do not
skip any item. Your answers are to be handled with strict confidentiality.
The Researchers
Questionnaire
I. This is about you. Please read carefully and put a check ( ) mark on the spaces provided
for.
Age_________ Gender ( / ) Male ( ) Female
Place of Work ( ) Hospital ( /) School
Position ( ) Staff ( ) Head Nurse/Unit Manager ( ) Supervisor ( ) Med. Nurse
( / ) Clinical Instructor/Faculty ( ) Level Chair/Dept. Chair
Length of Work Experience 8 years
PNA Membership ( ) Active ( / ) Inactive

II. Political Astuteness

Yes No
1. I am registered to vote. ( / ) ( )
2. I know where my voting precinct is located. ( / ) ( )
3. I voted in 2013 election. ( / ) ( )
4. I voted in 2010 election. ( ) ( / )
5. I recognized the names of the majority of the candidates on the ballot. ( / ) ( )
6. I was acquainted with the majority of issues in the 2013 election. ( /) ( )
7. I stay abreast of current health issues. ( /) ( )
8. I belong to the national professional organization. ( /) ( )
9. I participate as ____ in this organization.
a. Committee member (/ ) ( )
b. officer ( ) ( / )
10. I attended the most recent regional convention held by PNA. ( ) ( / )
11. I attended the last national convention of my organization. ( ) ( / )
12. I am aware of at least two issues discussed and the stands taken at this
convention. ( / ) ( )
13. I read newsletters/newspaper on a regular basis to stay abreast of current
health issues. ( / ) ( )
14. I know the name of my senators. ( ) ( )
15. I know the name of my congressman from my district. ( / ) ( )
16. I am acquainted with the voting record of at least one of the above in relation
to specific health issue. ( ) ( / )
17. I am aware of the stand taken by my senator/congressman in relation to specific
health issue. ( ) ( / )
18. I know whom to contact for information about health-related issues at the
local government level. ( / ) ( )
19. I know whom to contact for information about health-related issues at the
national government level. ( /) ( )
20. I know that my professional organization employs lobbyists at the congress. ( / ) ( )
21. I know that my professional organization employs lobbyists at the senate. ( ) ( /)
22. I know how to contact these lobbyists. ( ) ( / )
23. I contribute financially to my national professional organizations political
action committee. ( ) (/ )
24. I give information about effectiveness of elected officials to assist my
national professional organizations political action committee. ( /) ( )
25. I actively supported a senator/representative during the last election. ( ) ( / )
26. I have written to one of our senators/congressmen in the last year regarding
a health issue ( ) ( / )
27. I am personally acquainted with a senator/congressman or member of his
staff. ( / ) ( )
28. I know the process by which a bill is introduced in the senate and congress. ( / ) ( )
29. I know which senators or congressmen are supportive of nursing. ( ) ( / )
30. I know which senate or congress committees usually deal with health-related
issues. ( ) (/ )
31. I know the committees of which my congressman is a member. ( / ) ( )
32. I know of at least two health issues related to my profession that are currently
under discussion. ( / ) ( )
33. I am aware of the composition of the national board of nursing. ( ) ( / )
34. I know of the process whereby one becomes a member of the board of nursing. ( / ) ( )
35. I know what MDG stands for. ( / ) ( )
36. I know the purpose of MDG. ( / ) ( )
37. I am a member of the health board or advisory group to a health organization agency. ( ) ( / )
38. I attend public hearings related to health issues. ( ) ( / )
39. I find myself more interested in political issues now than in the past. ( / ) ( )