ProQOL Tool Survey Step 1 of 2 – Demographic Data Form I for Compassion Fatigue & Compassion Satisfaction DNP Project 0% Gender(Required)Please check your appropriate gender. If you select Other, please specify. Male Female Other Age at survey completion in years(Required)Please enter your age at the time of survey completion Marital Status(Required)Please enter your marital status. If you select Other, please specify. Single Married Divorced Other Ethnicity(Required)What is your ethnicity? If you select Other, please specify. White, Caucasian, Non-Hispanic African American, Non-Hispanic Hispanic Asian/Pacific Islander Other How many years have you been a nurse?(Required)Enter the number of years you have been a nurse How many years have you been a progressive care unit nurse?(Required)Please enter the number of years you have been practicing as a nurse in your area. Nursing Education Level(Required)Please enter your highest nursing education level. If you select Other, please specify. Diploma Associate Degree Bachelor Degree Master Degree Doctorate Degree (PhD or DNP) Other How many years have you worked at this hospital?(Required)Please enter the number of years you have been employed at a hospital as a registered nurse On average, how many hours a week do you work on the progressive care unit?(Required)Please enter the number of hours a week you practice at the progressive care unit Clinical Ladder Status(Required)Please enter your current Clinical Ladder Status RN I RN II RN III Supervisor Do you currently hold a national nursing certification?(Required)If you select Other, please specify. CCRN Critical Care Registered Nurse PCCN Progressive Care Certified Nurse None of the above Other What shift do you work a majority of the time?(Required)Please enter the shift you work the majority of the time Day shift Night shift I currently understand the definition of compassion fatigue(Required)Please enter whether or not you currently understand the definition of compassion fatigue No understandingSlight understandingUnderstandingComplete understandingI understand the signs and symptoms of compassion fatigue(Required)Please enter whether or not you currently understand the signs and symptoms of compassion fatigue No understandingSlight understandingUnderstandingComplete understandingI know about the resources available to address compassion fatigue(Required)Please select whether or not you currently know the resources available to address compassion fatigue Yes No © B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). /www.isu.edu/~bhstamm or www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. Compassion Satisfaction and Compassion Fatigue (ProQOL) Version 5 (2009)When you [help] people you have direct contact with their lives. As you may have found, your compassion for those you [help] can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a [helper]. Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days.Required Fields(Required)NeverRarelySometimesOftenVery OftenI get satisfaction from being able to [help] people.I feel invigorated after working with those I [help].I like my work as a [helper].I am pleased with how I am able to keep up with [helping] techniques and protocols.My work makes me feel satisfied.Required Fields(Required)NeverRarelySometimesOftenVery OftenI am not as productive at work because I am losing sleep over traumatic experiences of a person I [help].I feel trapped by my job as a [helper].I feel worn out because of my work as a [helper].I feel overwhelmed because my case [work] load seems endless.I feel “bogged down” by the system.Required Fields(Required)NeverRarelySometimesOftenVery OftenI have happy thoughts and feelings about those I [help] and how I could help them.I believe I can make a difference through my work.I am proud of what I can do to [help].I have thoughts that I am a “success” as a [helper].I am happy that I chose to do this work.Required Fields(Required)NeverRarelySometimesOftenVery OftenI am preoccupied with more than one person I [help].I jump or am startled by unexpected sounds.I find it difficult to separate my personal life from my life as a [helper].I think that I might have been affected by the traumatic stress of those I [help].Because of my [helping], I have felt “on edge” about various things.Required Fields(Required)NeverRarelySometimesOftenVery OftenI am happy.I feel connected to others.I have beliefs that sustain me.I am the person I always wanted to be.I am a very caring person.Required Fields(Required)NeverRarelySometimesOftenVery OftenI feel depressed because of the traumatic experiences of the people I [help].I feel as though I am experiencing the trauma of someone I have [helped].I avoid certain activities or situations because they remind me of frightening experiences of the people I [help].As a result of my [helping], I have intrusive, frightening thoughts.I can’t recall important parts of my work with trauma victims.© B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). /www.isu.edu/~bhstamm or www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made, and (c) it is not sold.
