Demographic Profile

Name: _____________________________________ Gender: _______

Marital Status: ______________________ Monthly Income: _____________

Legend

1- Very Poor
2- Poor
3- Acceptable
4- Good
5- Very Good

QUESTIONS 1 2 3 4 5

How would you rate the adequacy of the

following resources in your nursing
program:

• Clinical Rotation & opportunities

• Faculty support and availability

• Simulation labs & equipment

Please explain your ratings for any resource

that you feel is inadequate.

What specific improvements would you

recommend for each resource you
identified as inadequate?
 Legend:

5- Strongly Agree

4- Agree

3- Undecided

2- Disagree

1- Strongly Disagree

INTRAPERSONAL SKILLS Strongly Agree Undecided Disagree Strongly

Agree Disagree

1. I am an active listener who

pays attention to both verbal
and non-verbal cues.

2. I am consistent in my ability to
communicate effectively with
patients and colleagues.

3. I believe my intrapersonal
communication skills
contribute positively to my
overall nursing practice.

4. I am able to manage my
emotions effectively in
challenging situations.

5. I am aware on my emotions
and their impact on my
behavior.
 RLE PROTOCOLS 5 4 3 2 1

1. The RLE protocol helped me

identify areas for improvement in
my clinical skills.

2. I felt comfortable asking questions

and receiving feedback during the
RLE procedure.

3. The RLE protocol impact clear and

accurate feedback on my
performance.

4. The RLE protocol impact my

confidence in performing clinical
procedure.

5. The RLE protocol impact my

communication with my instructor
and peers
 Emotional Effects 5 4 3 2 1

1. The transition does contribute to

the feeling of competent.

2. The transition does help me

express my personal values.

3. The transition does help me

reflect the person I am.

4. The transition does give me a

sense of satisfaction.

5. The transition does help me

achieve something which

Psychosocial Effects 5 4 3 2 1
6. The transition made me confident
about my nursing knowledge.
1. The theory practice gap has
affected my overall stress levels
7. The transition boosted my self-
during clinical rotations.
esteem as a nursing student.

2. I often feel frustrated/ anxious

when I encountered situations in
clinical setting than differ from
what I learned in theoretical
lecture.

3. My self-esteem as a nursing
student is influenced my ability to
bridge the gap effectively.

4. The theory practice gap has

affected my relationship with
peers ang clinical instructor.
 Physical Status 5 4 3 2 1

1. The theory-practice gap in nursing

education has led to increased physical
fatigue during clinical rotations.

2. I experience physical discomfort

(headache, muscle tension, stomach
ache) as a result of the challenges
posed by the theory-practice gap.

3. The stress associated with the theory-

practice gap has impacted my sleep
patterns.

4. I often feel physically drained or

exhausted after encountering situations
in clinical settings that differ
significantly from what I learned in
theory.