Surveys 2016 August T Test0

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Exit Survey

Family Satisfaction with Care in the Intensive Care Unit© FS-ICU (24) How are we doing? Your opinions about your family member’s recent admission to the Intensive Care Unit (ICU) DEMOGRAPHICS: Please complete the following to help us know a little about you and your relationship to the patient.       I am: Male Female       I am years old       I am the patient's   Wife   Husband   Partner   Mother   Father   Sister   Brother   Daughter   Son   Other         Before this most recent event, have you been involved as a family member of a patient in an ICU (Intensive Care Unit)?   Yes   No       PART 1: SATISFACTION WITH CARE     How did we treat your family member (the patient) Excellent Very Good Good Fair Poor N/A Concern and Caring by ICU Staff - Pain - Breathlessness - Agitation -     How did we treat you? Excellent Very Good Good Fair Poor N/A Consideration of your needs Emotional support Co-ordination of care Concern and Caring by ICU       Name