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Survey

Survey

Partners in Care Parent Questionnaire

We appreciate your time and consideration in completing this survey, which has been sponsored by Partners in Care at NHHN. Partners in Care is a group of families and professionals working to strengthen communication and parental involvement. Our focus is to promote excellence in the delivery of family-centered care within NHHN.

The responses you give will help us know how to better serve our customers. This survey is voluntary. These answers are confidential and will not impact the immediate delivery of care to you or your child.

* Indicates required information

Please provide the following information to help us best serve you.

First Name
Last Name
Email
Street
City
State
Zip
Phone
Instruction
Please select the best answer for your experience in each category:
1=Poor, 2=Fair, 3=Very Good, 4=Good, 5=Excellent
Instruction
YOUR ARRIVAL
1.
Ease of finding your way around the hospital
              
2.
  Poor = 1 2 3 4 5 = Excellent  None 
Ease of admission process
3.
Amount of time it took to get situated in your room
              
4.
Courtesy demonstrated by health care personnel
              
5.
Comments:
Instruction
ENVIRONMENT AND ACCOMMODATIONS
6.
  Poor = 1 2 3 4 5 = Excellent  None 
Cleanliness of your room
7.
Noise level kept to a minimum within the hospital
              
8.
How well equipment worked in your room
              
9.
How well supplies were stocked in your room
              
10.
How well comfort needs were met
              
11.
Comments:
Instruction
ABOUT YOUR NURSES
12.
  Poor = 1 2 3 4 5 = Excellent  None 
Caring attitude shown
13.
Timeliness of nurses' responses to your needs
              
14.
Nurses' willingness to listen to you and your needs or those of your child
              
15.
Nurses' communication about the plan of care
              
16.
Comments:
Instruction
ABOUT YOUR PHYSICIAN(S)
17.
  Poor = 1 2 3 4 5 = Excellent  None 
Caring attitude shown
18.
Explanation of yours or your child's diagnosis, treatment and options
              
19.
  Poor = 1 2 3 4 5 = Excellent  None 
Willingness to listen
20.
Informed about the process of care prior to having tests/procedures
              
21.
Comments:
Instruction
MISCELLANEOUS
22.
Coordination of care by staff and physicians
              
23.
Sensitivity of staff and physicians to your cultural needs and issues
              
24.
Information about your or your child's needs while in the hospital
              
25.
Preparation for caring for yourself or your child after discharge
              
26.
Involvement with your own or your child's care during hospitalization
              
27.
Were you provided with information about community resources you may need?
              
28.
Comments:
29.
Overall recommendations:
30. *
Would you like to become an active participant on the family advisory board (Partners in Care)? If so, please fill out the demographic information at the top of the page.
      
 
 
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2131 S. 17th Street, Wilmington, NC 28401  |  910.343.7000