Greeley County Health Services Comfort Care Services Family Survey

Question Title

* 1. GCHS wants to improve the services we have available to our patients and their families during the end of life. Please take a few minutes to provide feedback from your perspective as a family member to some of the different services and options we are considering. We appreciate your feedback and all responses will be kept confidential.

	Very Important	Somewhat Important	Neutral	Not as Important	Not Important at all
Privacy for the patient. (Patient may not be easily seen from the hallway.)	Privacy for the patient. (Patient may not be easily seen from the hallway.) Very Important	Privacy for the patient. (Patient may not be easily seen from the hallway.) Somewhat Important	Privacy for the patient. (Patient may not be easily seen from the hallway.) Neutral	Privacy for the patient. (Patient may not be easily seen from the hallway.) Not as Important	Privacy for the patient. (Patient may not be easily seen from the hallway.) Not Important at all
Sufficient space in the room. (Limits to additional chairs or family members in the room.)	Sufficient space in the room. (Limits to additional chairs or family members in the room.) Very Important	Sufficient space in the room. (Limits to additional chairs or family members in the room.) Somewhat Important	Sufficient space in the room. (Limits to additional chairs or family members in the room.) Neutral	Sufficient space in the room. (Limits to additional chairs or family members in the room.) Not as Important	Sufficient space in the room. (Limits to additional chairs or family members in the room.) Not Important at all
Comfort for the family. (Several comfortable chairs for visiting family members.)	Comfort for the family. (Several comfortable chairs for visiting family members.) Very Important	Comfort for the family. (Several comfortable chairs for visiting family members.) Somewhat Important	Comfort for the family. (Several comfortable chairs for visiting family members.) Neutral	Comfort for the family. (Several comfortable chairs for visiting family members.) Not as Important	Comfort for the family. (Several comfortable chairs for visiting family members.) Not Important at all
Access for family - room is near the front lobby and easily entered and exited by main door.	Access for family - room is near the front lobby and easily entered and exited by main door. Very Important	Access for family - room is near the front lobby and easily entered and exited by main door. Somewhat Important	Access for family - room is near the front lobby and easily entered and exited by main door. Neutral	Access for family - room is near the front lobby and easily entered and exited by main door. Not as Important	Access for family - room is near the front lobby and easily entered and exited by main door. Not Important at all
Privacy for family - room is near the former OB area with less hallway traffic.	Privacy for family - room is near the former OB area with less hallway traffic. Very Important	Privacy for family - room is near the former OB area with less hallway traffic. Somewhat Important	Privacy for family - room is near the former OB area with less hallway traffic. Neutral	Privacy for family - room is near the former OB area with less hallway traffic. Not as Important	Privacy for family - room is near the former OB area with less hallway traffic. Not Important at all
Additional support services - would it be helpful to have other team members to assist with patient and/or family needs?	Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Very Important	Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Somewhat Important	Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Neutral	Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Not as Important	Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Not Important at all
Entertainment options such as television, video, music, books.	Entertainment options such as television, video, music, books. Very Important	Entertainment options such as television, video, music, books. Somewhat Important	Entertainment options such as television, video, music, books. Neutral	Entertainment options such as television, video, music, books. Not as Important	Entertainment options such as television, video, music, books. Not Important at all

Very Important

Somewhat Important

Neutral

Not as Important

Not Important at all

Privacy for the patient. (Patient may not be easily seen from the hallway.)

Privacy for the patient. (Patient may not be easily seen from the hallway.) Very Important

Privacy for the patient. (Patient may not be easily seen from the hallway.) Somewhat Important

Privacy for the patient. (Patient may not be easily seen from the hallway.) Neutral

Privacy for the patient. (Patient may not be easily seen from the hallway.) Not as Important

Privacy for the patient. (Patient may not be easily seen from the hallway.) Not Important at all

Sufficient space in the room. (Limits to additional chairs or family members in the room.)

Sufficient space in the room. (Limits to additional chairs or family members in the room.) Very Important

Sufficient space in the room. (Limits to additional chairs or family members in the room.) Somewhat Important

Sufficient space in the room. (Limits to additional chairs or family members in the room.) Neutral

Sufficient space in the room. (Limits to additional chairs or family members in the room.) Not as Important

Sufficient space in the room. (Limits to additional chairs or family members in the room.) Not Important at all

Comfort for the family. (Several comfortable chairs for visiting family members.)

Comfort for the family. (Several comfortable chairs for visiting family members.) Very Important

Comfort for the family. (Several comfortable chairs for visiting family members.) Somewhat Important

Comfort for the family. (Several comfortable chairs for visiting family members.) Neutral

Comfort for the family. (Several comfortable chairs for visiting family members.) Not as Important

Comfort for the family. (Several comfortable chairs for visiting family members.) Not Important at all

Access for family - room is near the front lobby and easily entered and exited by main door.

Access for family - room is near the front lobby and easily entered and exited by main door. Very Important

Access for family - room is near the front lobby and easily entered and exited by main door. Somewhat Important

Access for family - room is near the front lobby and easily entered and exited by main door. Neutral

Access for family - room is near the front lobby and easily entered and exited by main door. Not as Important

Access for family - room is near the front lobby and easily entered and exited by main door. Not Important at all

Privacy for family - room is near the former OB area with less hallway traffic.

Privacy for family - room is near the former OB area with less hallway traffic. Very Important

Privacy for family - room is near the former OB area with less hallway traffic. Somewhat Important

Privacy for family - room is near the former OB area with less hallway traffic. Neutral

Privacy for family - room is near the former OB area with less hallway traffic. Not as Important

Privacy for family - room is near the former OB area with less hallway traffic. Not Important at all

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs?

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Very Important

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Somewhat Important

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Neutral

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Not as Important

Additional support services - would it be helpful to have other team members to assist with patient and/or family needs? Not Important at all

Entertainment options such as television, video, music, books.

Entertainment options such as television, video, music, books. Very Important

Entertainment options such as television, video, music, books. Somewhat Important

Entertainment options such as television, video, music, books. Neutral

Entertainment options such as television, video, music, books. Not as Important

Entertainment options such as television, video, music, books. Not Important at all

Question Title

Question Title

* 2. Please rate the following in importance from your experience in our facility.