すべてのテンプレート
Industry-Specific

Patient Experience of Nursing Care Assessment

Captures how patients or clients experienced the nursing care they received — communication, responsiveness, pain management, and discharge preparation — for hospitals, clinics, and home health teams. An AI follow-up interview reconstructs the specific moment that most shaped their overall rating, surfacing concrete coaching moments beyond a satisfaction score.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share your experience with the nursing care you received. Your honest answers help the nursing team improve. Your responses are completely confidential and anonymized. This takes about 4-5 minutes.

Q02
選択式必須

What type of visit or stay best describes your care?

  • Inpatient hospital stay
  • Outpatient clinic visit
  • Emergency department visit
  • Home health visit
  • Other
Q03
オピニオンスケール必須

Based on this visit or stay, how likely are you to recommend our nursing team's care to family or friends?

スケール: 0 – 10
最小:Not at all likely最大:Extremely likely
Q04
マトリクス必須

Thinking about the nurses who cared for you, how often did each of the following happen?

5行 × 4列
  • Nurses listened carefully to my questions and concerns
  • Nurses explained things in a way I could understand
  • Nurses treated me with courtesy and respect
  • Nurses responded to my call button or requests within a reasonable time
  • Nurses kept me informed about my care plan
列: Never · Sometimes · Usually · Always
Q05
オピニオンスケール

If you experienced pain during this visit, how well did the nursing staff manage it?

スケール: 1 – 5
最小:Not managed well at all最大:Managed extremely well
Q06
評価スケール必須

How clear were the instructions nurses gave you about medications or home care before you left?

範囲: 1 – 5
最小:Very unclear最大:Very clear
Q07
AIインタビュー

Reconstruct the specific moment during this visit that most shaped the respondent's overall recommendation rating: what happened, which shift or moment it was, and exactly what a nurse said or did (or failed to do). If the rating was low, identify the single most important lapse in communication, responsiveness, or pain management, and ask what would have changed it. If the rating was high, pin down the specific action or nurse behavior that stood out so it can be reinforced as a best practice.

Q08
ランク付け

Rank these aspects of nursing care from most to least important to you personally.

  1. Clear communication and listening
  2. Effective pain management
  3. Quick response to call button or requests
  4. Clear explanation of medications and procedures
  5. Emotional support and compassion
  6. Coordination between nurses and doctors
ドラッグして順位を付ける
Q09
選択式

During this visit, how often did you wait longer than expected for a nurse to respond to your call button or requests?

  • Never
  • Once
  • A few times
  • Many times
  • Not applicable
Q10
自由回答(長文)

Is there anything a nurse did especially well, or anything they could improve, that we haven't asked about?

Q11
選択式

Which age range best describes you?

  • Under 18
  • 18-29
  • 30-44
  • 45-59
  • 60-74
  • 75 or older
  • Prefer not to say
Q12
選択式

How do you describe your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q13
メッセージ

Thank you for sharing your experience! Your responses will be reviewed by the nursing leadership team to recognize great care and identify where we can do better.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Includes a dedicated AI follow-up interview that reconstructs the specific moment during the visit that most shaped the patient's overall rating, turning a single score into a concrete coaching moment.
  • Covers the full experience arc patients actually care about: nurse responsiveness (wait-times question), communication frequency (matrix on nurse behaviors), pain management effectiveness, and clarity of discharge/medication instructions.
  • Uses a ranking question to reveal which aspects of nursing care (e.g., communication, pain control, promptness) each respondent personally values most, not just how they rated the visit.
  • Closes with a transparent note that responses are reviewed by the nursing leadership team, and results are compiled into an auto-generated report rather than left as raw export data.

Jotform

Hospice Nursing Assessment Form Template

A fielding-ready form template aimed at hospice nursing assessment, built on Jotform's drag-and-drop form builder. It reads as a general clinical/intake assessment form rather than a purpose-built patient-experience survey, and like all Jotform templates it is a static question set with no adaptive interviewing layer.

優れている点

  • Easy to customize fields and branding within Jotform's established form builder
  • Can integrate with Jotform's broader ecosystem (e-signatures, tables, conditional logic)
  • Likely offers a free tier for basic use

物足りない点

  • Static question list with no adaptive AI follow-up to probe why a rating was given
  • No per-response quality scoring or automated coaching-moment extraction
  • No voice AI interview option or transparent prompt methodology

Typeform

Nursing Assessment Form Template

A conversational, one-question-at-a-time nursing assessment template built on Typeform's design-forward form engine. It's framed as a general nursing assessment tool rather than an experience/satisfaction survey specifically, and is a fixed set of questions with no follow-up logic beyond simple branching.

優れている点

  • Polished, conversational UI that tends to improve completion rates
  • Simple embedding and sharing across web and mobile
  • Familiar builder for teams already using Typeform for other surveys

物足りない点

  • No adaptive AI interview to reconstruct the specific moment behind a rating
  • No automated quality scoring or auto-generated analysis report
  • No transparent, published prompt methodology behind any 'smart' logic

よくあるご質問

「Patient Experience of Nursing Care Assessment」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が13問含まれており、最初の設問は次のとおりです:「Thanks for taking a few minutes to share your experience with the nursing care you received. Your honest answers help th…」・「What type of visit or stay best describes your care?」・「Based on this visit or stay, how likely are you to recommend our nursing team's care to family or friends?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

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