Republic of the Philippines

Western Mindanao State University

COLLEGE OF NURSING
Zamboanga City

July __, 2016

Nursia M. Barjose, RN,MN,DSN

Dean, College of Nursing
Western Mindanao State University

Ma am,
Greetings!
We, the level IV Nursing students of the Western Mindanao State University College of
Nursing are conducting a research study entitled Factors Affecting the Self-Esteem among 4 th
year Nursing Students, as part of our requirement in Nursing Research II
In line with this, we respectfully ask for your permission to allow us to implement our research
work in the Western Mindanao State University College of Nursing to senior nursing students
who are enrolled for the school year 2016-2017. The gathering of date shall be conducted after
their classes and/or during their vacant time. The implementation phase will last for about a
month
We are anticipating for you positive response. Thank you and God bless!

Respectfully yours,
Jehanna Mar E. Abdurahman
Group Leader

Republic of the Philippines

Western Mindanao State University
COLLEGE OF NURSING
Zamboanga City
PARTICIPANT INFORMATION

AUGUST ____, 2016

Dear Respondents,
Greetings!
We, the undersigned level IV Nursing students of the Western Mindanao State
University College of Nursing are conducting a research study entitled Factors Affecting the
Self-Esteem among 4th year Nursing Students, as part of our requirement in Nursing Research
II. The main purpose of this study is to determine the factors affecting the self-esteem of selected
senior nursing students.
This study would help in determining the level of self-esteem of student nurses and the
factors that affect it, as a whole. As a result, this helps in enhancing your awareness about your
self-esteem and how significant an impact it would have on your performance as an individual
and as a nursing student.
We are hoping that you could voluntarily spare us some of your time to answer the
questionnaire likert scale as honestly as possible. Your answers will be of great help to our study.
It is optional, but if you so desire, you can know about your level of self-esteem and avail
resources provided by the researchers, to improve it. Simply fill in your name on the form. Be
assured that all information appearing herein will be kept strictly confidential and be used for
academic purpose only.
Thank you very much!
Attached herewith is the copy of the questionnaire likert scale.
Respectfully yours,
Jehanna Mar E. Abdurahman
Group Leader
(09268277404)

Republic of the Philippines

Western Mindanao State University
COLLEGE OF NURSING
Zamboanga City
INFORM CONSENT
We, the level IV Nursing students of the Western Mindanao State University College
of Nursing are conducting a research study entitled Factors Affecting the Self-Esteem among 4 th
year Nursing Students, as part of our requirement in Nursing Research II. The study seeks to
obtain the participation of the 4th year nursing students who are enrolled for the school year
2016-2017, for this reason we are requesting your valuable cooperation.
If you agree to participate in the study, a questionnaire likert scale will be distributed
during the conduct of the study. All information will be kept confidential.
I hereby certify that, I, ________________________________________, understand
the explanations above and voluntarily agree to participate in this study, and that I am willing to
answer all the questions in the questionnaire likert scale. I am also made aware that I can
withdraw from participating in the study any tine if I wish to do so.
The benefit that I will derive from this study is, knowing the factors affecting the selfesteem among nursing students; and if I so desire, I can know about my level of self-esteem and
avail resources provided by the researchers, to improve it. I understand that I will receive no
monetary compensation for my participation in this study. Furthermore, all the information that I
provide will be confidential and can be given only to the people working in this study.
If the results of the study are published, my identity cannot be revealed. I also
understand that I have the right to refuse to participate and to withdraw from the study whenever
I choose without jeopardizing my job or my current or future health care.
I was given the opportunity to ask questions about the study, and all of them were
answered to my satisfaction. By signing this document, I give my consent to participate in this
study as a respondent.
Signature:
__________________________________

________________

Respondents Signature over Printed Name

Date

Informed consent obtained by: ________________________

Researchers name and Signature

QUESTIONNAIRE
(OPTIONAL) NAME: _________________________________ BIRHTDAY: ______________
YEAR/SECTION:
Gender:

Female
Male

The main purpose of this study is to determine the factors affecting the self-esteem of selected
senior nursing students.

A.
I.

Utilizing the Rosenberg Self-Esteem Scale in Assessing Ones

General Feelings of Self

Instructions: Below is a list of statements dealing with your general feelings

about yourself, which you will check for self-assessment. If you strongly agree,
check SA. If you agree with the statement, check A. If you disagree, check D. If
you strongly disagree, check SD.
Please write a brief reason for your self-assessment for each item, in
the column provided for.
Strongl Agree Disagr
Strongly
Reason for selfy
(A)
ee
Disagree
assessment
Agree
(D)
(SD)
(SA)
1. On the whole, I
am satisfied
with myself.
2.

At times, I think
I am no good at
all.

3.

I feel that I
have a number
of good
qualities.

4.

I am able to do
things as well
as most other

people.
5.

I feel I do not
have much to
be proud of.

6.

I certainly feel
useless at
times.

7.

I feel that Im a
person of
worth, at least
on an equal
plane with
others.

8.

I wish I could
have more
respect for
myself.

9.

All in all, I am
inclined to feel
that I am a
failure.

1
0.

I take a positive
attitude toward
myself.

II.

Utilizing the Rosenberg Self-Esteem Scale in Assessing Ones

Self as a Nursing Student

Instructions: Below is a list of statements dealing with your feelings about

yourself as a nursing student, which you will check for self-assessment. If you
strongly agree, check SA. If you agree with the statement, check A. If you
disagree, check D. If you strongly disagree, check SD.
Please write a brief reason for your self-assessment for each item, in
the column provided for.
Strongl Agree Disagr
Strongly
Reason for selfy
(A)
ee
Disagree
assessment as a nursing
Agree
(D)
(SD)
student
(SA)
1. On the whole, I
am satisfied
with myself.
2.

At times, I think
I am no good at
all.

3.

I feel that I
have a number
of good
qualities.

4.

I am able to do
things as well
as most other
people.

5.

I feel I do not
have much to
be proud of.

6.

I certainly feel
useless at
times.

7.

I feel that Im a
person of
worth, at least
on an equal
plane with
others.

8.

I wish I could
have more
respect for
myself.

9.

All in all, I am
inclined to feel
that I am a
failure.

1
0.

I take a positive
attitude toward
myself.

B.
Based on your assessment, what suggestions or recommendations do you have to improve your
self-esteem as a nursing student?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________