Develop a research instrument that will be used to collect data from the sample population.

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Select the population and sample that is the  focus of the action research project.
Describe the method of research to be applied and why it is most appropriate for the study. Describe the population, the sample, and how you intend to gather data to address the research problem.
Develop a research instrument that will be used to collect data from the sample population.
For help with questionnaires, view “PSC 495: Questionnaire Examples.”

Demographic Information:
For each of the following items, put an X beside the choice that best describes you:
    1.Gender Male Female 
    2.Total number of
years as a nurse
 1-5 6-10 
 11-15 16-20 
    3.Assigned Department (please list) 
Checklist Items:
Below is a list of educational resources. Put a check in front of each resource you think is adequately available in your department:
    4. Up-to-date textbooks and manuals
    5. Instructional VCRs
    6. Department-based computers
    7. Educational programs
    8.___________________Trade journals
Likert Scale Items:
The following are statements that describe a school’s curriculum. Read each statement and place a check in the box as to whether you strongly agree (SA), agree (A), are uncertain (U), disagree (D), or strongly disagree (SD) with each statement.
In my school, the curriculum:SAAUDSD
    9.Is up to date     
 10.Emphasizes critical thinking outcomes     
 11.Is familiar to all teachers     
 12.Is followed by all teachers     
 13.Can be adapted to meet individual student needs     
Free Response Items:
 14.How you would rate the nursing service quality you received? Very good  Good
    Fair Poor
 15.Write a brief explanation of why you feel as you do about the quality of nursing services.
 16.Please make additional comments you have regarding nursing services delivered during your hospital stay.


Gay, L. R., &Airasian, P. (2003). Educational research; Competencies for analysis and applications (7th ed.). Columbus, OH: Merrill Prentice Hall.

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