Nursing Care Feedback Form
Gather feedback about nursing care to improve patient experience.
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About this template
The Nursing Care Feedback Form is designed to gather feedback from patients about their experience with nursing care. This form helps healthcare providers assess patient satisfaction and identify areas for improvement. The form starts with a welcome message to engage the patient and encourage their participation.
The first question in the form asks patients to rate their satisfaction with the nursing care on a scale of 1 to 10, using the Net Promoter Score (NPS) approach. This question provides a quick and straightforward measure of patient satisfaction.
Patients are then asked to provide specific details about their experience with the nursing care in a textarea input. This open-ended question allows patients to express their thoughts and concerns in their own words.
The next question assesses the effectiveness of communication between the nursing staff and the patient. Patients can indicate their response with a thumbs-up or thumbs-down emoji. If the patient answers ‘No,’ an additional textarea question appears to capture the areas where communication was lacking.
Following that, the form includes a likert scale question to evaluate the responsiveness of the nursing staff. Patients can choose from options ranging from ‘Excellent’ to ‘Poor.’ This question provides insights into the patient’s perception of the nursing staff’s responsiveness.
Patients are then asked if they were involved in decisions about their care, with a thumbs-up or thumbs-down response. If the patient answers ‘No,’ an optional textarea appears for them to provide further information.
The next question uses a Customer Satisfaction (CSAT) approach to determine if the patient would recommend the nursing care to others. Patients can express their level of satisfaction using a range of smiley faces.
The form concludes with an optional textarea for patients to share any additional comments or suggestions for improvement. Finally, a thank you message is displayed to express appreciation for the patient’s participation.
By using the Nursing Care Feedback Form, healthcare providers can gather valuable feedback from patients, identify areas for improvement in nursing care, and enhance the overall patient experience.