Exit this survey >>

NASN Regional/District Nurse Feedback Form:CO Affiliate

1. Diabetes Management Nurse On-Line Survey

The following questions will ask for feedback on the MOST RECENT consultation you received from your Diabetes Resource Nurse.

Question Title

* 1. Prior to this consultation, did you know who your Diabetes Resource Nurse was?

Yes

No

Question Title

* 2. How did you request a consultation with your Diabetes Resource Nurse (DRN)?

Direct contact (e.g.,phone,email) with DRN

Contacted CO Department of Education (i.e., Kathy Patrick)

Other (please specify)

Question Title

* 3. How would you rate your level of knowledge about the topic (e.g., glucose monitoring) for which your received consultation BEFORE meeting with your Diabetes Resource Nurse?

Beginner

Slightly knowledgeable

Somewhat knowledgeable

Very knowledgeable

Expert

Question Title

* 4. How would you rate your level of knowledge about the topic (e.g., glucose monitoring) for which your received consultation AFTER meeting with your Diabetes Resource Nurse?

Beginner

Slightly knowledgeable

Somewhat knowledgeable

Very knowledgeable

Expert

Question Title

* 5. How would you rate the quality of assistance you received from your Diabetes Resource Nurse?

Excellent

Very Good

Good

Fair

Poor

Question Title

* 6. How would you rate the knowledge and skill of your Diabetes Resource Nurse?

Excellent

Very Good

Good

Fair

Poor

Question Title

* 7. How would you rate your Diabetes Resource Nurse's sensitivity to your needs?

Excellent

Very Good

Good

Fair

Poor