Republic oI the Philippines

PALAWAN STATE UNIVERSITY

COLLEGE OF NURSING AND HEALTH SCIENCES
Puerto Princesa City
The Respondents

Sir/Madam:
Greetings oI peace!
The undersigned are 4
th
year Bachelor oI Science in Nursing
students oI the Palawan State University will be conducting a
research study entitled 'Assessment of Burnout Level Among
Nurses in a Selected Hospital in Puerto Princesa City. This
is in partial IulIilment oI our requirements in the subject
Nursing Research.
In connection with this matter, we would like to ask you iI
you could be our respondents on the said study.
We are looking Iorward Ior your kindness and well
participation in inducting the said research. More power and
May God always guide and bless you.
RespectIully yours,
Ivan Cris Porto
John Christian Macandog
Researchers
Age:_____ Gender: _______ Civil Status: _______________
Religion: ________________
Area/Ward:_________________

1. When did you start working at this hospital?
| | 1- 3 years
| | 4 - 6 years
| | 8 9 years
| | more than 10 years
2. Do you have break time in your shiIt?
3. II yes, how long does it take?

4. How many hours you work in a week? You may state the work
hours completed last week.

DIRECTION: Put a check on the box that corresponds your
answer.
Ieldom Iometimet Alwuyt
I do not Ieel annoyed or irritated at work
I do not Ieel like I accomplish my work all the time
I do not Iind myselI withdrawing Irom co-workers
I do not Ieel like everything I`m asked to do is an
imposition

I do not Iind myselI increasingly insensitive or callous
to clients, co-workers, or associates

Work isn`t boring, tedious, and routine-like
I don`t Ieel like I`m at a standstill in my career
I Iind myselI Ieeling positive about work and Iocusing
only on its good aspects

I Iind myselI accomplishing more than I ever have
beIore

I have no trouble organizing my work and my time
I`m more patient than I`ve ever been beIore
I Ieel adept and skillIul in making changes at work
I don`t take out my work Irustrations at home
I don`t avoid personal contact more than I ever had
I don`t Iind myselI asking whether my job is right Ior
me

I Iind myselI thinking positively about work even
when I go to bed at night

I approach each new day with the attitude oI 'I know
I`m going to make it through another day.

I don`t Ieel that everyone at work doesn`t care about
what I do

I spend time working and not avoiding any work I
was assigned to do

I don`t Ieel tired or exhausted at work even when I get
enough sleep at night