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Kuisioner Colcaba

The document is a general comfort questionnaire asking a person to rate their level of agreement with 48 statements about their current comfort on a scale of 1 to 4. It aims to assess different factors that may impact a person's comfort, such as their physical relaxation, independence, social support system, outlook, and environmental conditions. Respondents are asked to consider their comfort at the moment of filling out the questionnaire and circle the number that best matches their feelings for each statement.

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Dwi Noviyani
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147 views2 pages

Kuisioner Colcaba

The document is a general comfort questionnaire asking a person to rate their level of agreement with 48 statements about their current comfort on a scale of 1 to 4. It aims to assess different factors that may impact a person's comfort, such as their physical relaxation, independence, social support system, outlook, and environmental conditions. Respondents are asked to consider their comfort at the moment of filling out the questionnaire and circle the number that best matches their feelings for each statement.

Uploaded by

Dwi Noviyani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Code #____________________

GENERAL COMFORT QUESTIONNAIRE

Thank you VERY MUCH for helping me in my study of the concept COMFORT. Below are statements
that may describe your comfort right now. Four numbers are provided for each question; please circle the
number you think most closely matches your feeling. Relate these questions to your comfort at the moment
you are answering the questions.

Below is an example:
Strongly Strongly
I am glad I can fill out this questionnaire about my comfort……. Agree Disagree
4 3 2 1

1. My body is relaxed right now 4 3 2 1

2. I feel useful because I’m working hard 4 3 2 1

3. I have enough privacy 4 3 2 1

4. There are those I can depend on when I need help 4 3 2 1

5. I don’t want to exercise 4 3 2 1

6. My condition gets me down 4 3 2 1

7. I feel confident 4 3 2 1

8. I feel dependent on others 4 3 2 1

9. I feel my life is worthwhile right now 4 3 2 1

10. I am inspired by knowing that I am loved 4 3 2 1

11. These surroundings are pleasant 4 3 2 1

12. The sounds keep me from resting 4 3 2 1

13. No one understands me 4 3 2 1

14. My pain is difficult to endure 4 3 2 1

15. I am inspired to do my best 4 3 2 1

16. I am unhappy when I am alone 4 3 2 1

17. My faith helps me to not be afraid 4 3 2 1

18. I do not like it here 4 3 2 1

19. I am constipated right now 4 3 2 1

20. I do not feel healthy right now 4 3 2 1

21. This room makes me feel scared 4 3 2 1

22. I am afraid of what is next 4 3 2 1


Strongly Strongly
Agree Disagree
4 3 2 1

23. I have a favorite person(s) who makes me feel cared for 4 3 2 1

24. I have experienced changes which make me feel uneasy 4 3 2 1

25. I am hungry 4 3 2 1

26. I would like to see my doctor more often 4 3 2 1

27. The temperature in this room is fine 4 3 2 1

28. I am very tired 4 3 2 1

29. I can rise above my pain 4 3 2 1

30. The mood around here uplifts me 4 3 2 1

31. I am content 4 3 2 1

32. This chair (bed) makes me hurt 4 3 2 1

33. This view inspires me 4 3 2 1

34. My personal belongings are not here 4 3 2 1

35. I feel out of place here 4 3 2 1

36. I feel good enough to walk 4 3 2 1

37. My friends remember me with their cards and phone calls 4 3 2 1

38. My beliefs give me peace of mind 4 3 2 1

39. I need to be better informed about my health 4 3 2 1

40. I feel out of control 4 3 2 1

41. I feel crummy because I am not dressed 4 3 2 1

42. This room smells terrible 4 3 2 1

43. I am alone but not lonely 4 3 2 1

44. I feel peaceful 4 3 2 1

45. I am depressed 4 3 2 1

46. I have found meaning in my life 4 3 2 1

47. It is easy to get around here 4 3 2 1

48. I need to feel good again 4 3 2 1

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