Appendix A.

Survey Instrument
Self-Care Practices of Music Educators

The following series of statements represent common personal and professional self-care
practices. Please respond indicating the extent to which you engage in the action or activity
described.

Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I participate in physical
[] [] [] [] []
exercise. *
I choose to participate in
school-related social and [] [] [] [] []
community events.
I try to be aware of my
[] [] [] [] []
feelings and needs.
I spend time with family
[] [] [] [] []
and/or friends.
I maintain a professional
[] [] [] [] []
support system.

Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I find ways to cultivate a
sense of social connection in [] [] [] [] []
my life.
I take breaks throughout the
[] [] [] [] []
workday.
I make personal connections
on campus to avoid feeling [] [] [] [] []
isolated.
I spend time with people
[] [] [] [] []
whose company I enjoy.
I seek guidance or
[] [] [] [] []
counseling when necessary.

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**
Shaded items are Personal Self-Care items while unshaded are Professional Self-Care items. Items were not
distinguished by domain on original instrument as seen by participants.
Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I try to reduce stress by
proactively navigating
[] [] [] [] []
challenging situations in my
professional work.
I confide in a trusted
colleague regarding work- [] [] [] [] []
related stressors.
I connect with organizations
in my professional
[] [] [] [] []
community that are
important to me.
I make a conscious effort to
appreciate positive things in [] [] [] [] []
my life.

Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I take time off when I am
[] [] [] [] []
not feeling well.
I participate in activities that
promote my professional [] [] [] [] []
development.
I seek out activities or
people that encourage [] [] [] [] []
and/or comfort me.
I avoid over-commitment to
[] [] [] [] []
work responsibilities.
I tell colleagues about
positive workplace [] [] [] [] []
experiences.

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Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I cultivate professional
relationships with my [] [] [] [] []
colleagues.
I make physical activity part
[] [] [] [] []
of my regular routine.
I take some time for
[] [] [] [] []
relaxation each day.
I anticipate situations which
may cause me stress at [] [] [] [] []
work.
I see a doctor or other
medical professional when I [] [] [] [] []
have health concerns.

Respond to the following prompts

Strongly Agree Neutral Disagree Strongly

agree Agree
I find ways to stay current in
[] [] [] [] []
professional knowledge.
I monitor my feelings and
reactions to students and [] [] [] [] []
colleagues.
I eat a balanced and healthy
[] [] [] [] []
diet.
I make an effort to get
[] [] [] [] []
enough sleep each night.
I share my feelings with
others during stressful times [] [] [] [] []
in my life.

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Demographic Information

What is your age?

Enter age: _________________
( ) Prefer not to answer
Gender
( ) Male
( ) Female
( ) Non-binary
( ) Prefer to self-describe: _______________________
( ) Prefer not to answer

How many years of K-12 classroom music teaching experience do you have?
______________________

What is your primary teaching identity?

( ) Band
( ) Choir
( ) Orchestra
( ) General
( ) Other: __________________

What types of music classes do you teach currently? (check all that apply)
[ ] Band
[ ] Choir
[ ] Orchestra
[ ] Mariachi
[ ] Elementary General
[ ] Secondary General/Music Appreciation
[ ] Guitar
[ ] Theory/Composition
[ ] Keyboard
[ ] Jazz
[ ] Non-Music Course(s)
[ ] Other Music: ______________

What grade levels do you teach? (check all that apply)

[ ] Pre-K
[]K
[ ] 1st
[ ] 2nd
[ ] 3rd
[ ] 4th
[ ] 5th
[ ] 6th
[ ] 7th
[ ] 8th
[ ] 9th
[ ] 10th
[ ] 11th
[ ] 12th

Do you work at a Title I School?

( ) Yes
( ) No
( ) Unsure

Approximately how many students are enrolled in your classes?

___________________________

How many teachers do you share your music workload with?

( ) I work by myself
( ) 1 other person
( ) 2 other people
( ) 3 other people
( ) 4 other people
( ) 5+ other people