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QUESTIONNAIRE CHECKLIST

Objective:
To examine some factors influencing the clinical learning experiences of student nurses.
To find students approach to clinical exposure. To analyze the effect of clinical experiences on
students’ academic performances.

Personal Data:
Name: (Optional)
Age:
Gender: Male ( ) Female ( )

Direction: Rate yourself based on your experience encountered on the following aspects
(Possible problem in the clinical area and possible solution) encountered by Nursing Students
by putting () on the space provided corresponding to your choice answer. Be guided by the
following description and number points.

Scale:
5 – Strongly Agree
4 – Agree
3 – Uncertain
2 – Disagree
1 – Strongly Disagree

Factors that affect clinical Strongly Strongly


learning experience of Agree Agree Uncertain Disagree Disagree
student:
5 4 3 2 1
Clinical instructor to student
ratio
Listening to lectures

Observations
Return Demo

Influence of hospital staff on


learning
Area of affiliation/hospital

Reasons to anxious in clinical


area

Areas that needs Strongly Strongly


improvement that affect Agree Agree Uncertain Disagree Disagree
clinical learning experience:
5 4 3 2 1
Clinical instructor

Area of affiliation

Clinical Staff

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