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* 1. Did staff introduce themselves to you before providing care?

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* 2. Please answer the following questions about your care. 

  Yes, Always Yes, Usually Sometimes Never
Did staff explain their role before they offered care?
If you had any questions or concerns regarding your condition or treatment, did the staff discuss this with you? 
Did staff address any anxiety or fears you had in a way that you felt cared for?
Before giving any  new medications, did staff describe possible side effects in a way you could understand? 
Did you feel you were treated with dignity and respect during your hospital stay?
Were you satisfied with the overall care you received during your hospital stay?

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* 3. Were you or your caregiver asked what your NEEDS or CULTURAL VALUES are when making decisions about your care?
(Your unique needs, customs, beliefs, rituals, traditions, such as any or all of the following: accessibility needs; dietary restrictions such as gluten-free, vegetarian, etc.; interpreter assistance for all languages; family members or close friends present; visits by clergy members, elders, or spiritual leaders; visits to the multi-denominational chapel; access to the traditional ceremonial room; traditional healing options; sacraments or sacred rituals; who you would like to make decisions about your care if not you; etc.)

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* 4. Were you satisfied with the cleanliness of your room?

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* 5. Were you satisfied with the quality of the food you received?

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* 6. Were you offered a Miichim (traditional food program) meal?

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* 7. After the birth of your baby, did you have the opportunity to have skin to skin contact with your baby?

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* 8. If you were not given the opportunity to have skin to skin contact, was the separation from your baby after birth for medical reasons?

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* 9. Please answer the following questions about feeding your baby.

  Always Sometimes Usually Never Don't know/Not applicable
Did you make an informed choice or decision between breastfeeding or bottle feeding your baby?
If you chose to breastfeed, were you offered support on proper positioning techniques from the Maternity Staff or the Lactation Consultant?
Were you offered a visit from the Lactation Consultant?
If you chose to bottle feed, were you informed on how to safely bottle feed your baby? 
If you chose to bottle feed, were you informed about how much to feed your baby per day?

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* 10. Were you told by health care professional that your baby needed to be supplemented with formula for medical reasons?

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* 11. Please answer the following questions about maintaining and storing your milk supply if separated from your baby.

  Yes No I wasn't separated from my baby
If you were separated from your baby, were you offered support on how to properly hand express or pump your breasts to maintain your milk supply?
If you were separated from your baby, were you offered support or instructed on how to store expressed breast milk for your baby?

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* 12. Is there anyone you would like to recognize for the care he or she provided during your stay?

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* 13. Would you recommend Sioux Lookout Meno Ya Win Health Centre to family and friends? 

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* 14. Please rate Sioux Lookout Meno Ya Win Health Centre using any number from 1 - 10, where 10 is the BEST health centre possible and 1 is the WORST health centre possible

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* 15. Do you have any other feedback you would like to provide?

Thank you for taking the time to complete this survey. If you have other comments or feedback, please ask any staff member for a Compliments/Feedback form. 

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