Q01
메시지
모든 템플릿
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.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
질문 13개 · 약 7분
Q02
객관식필수
What type of visit or stay best describes your care?
- Inpatient hospital stay
- Outpatient clinic visit
- Emergency department visit
- Home health visit
- Other
Q03
의견 척도필수
Based on this visit or stay, how likely are you to recommend our nursing team's care to family or friends?
척도: 0 – 10
최소:Not at all likely최대:Extremely likely
Q04
매트릭스필수
Thinking about the nurses who cared for you, how often did each of the following happen?
5개 행 × 4개 열
- 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
열: Never · Sometimes · Usually · Always
Q05
의견 척도
If you experienced pain during this visit, how well did the nursing staff manage it?
척도: 1 – 5
최소:Not managed well at all최대:Managed extremely well
Q06
평점 척도필수
How clear were the instructions nurses gave you about medications or home care before you left?
범위: 1 – 5
최소:Very unclear최대:Very clear
Q07
AI 인터뷰
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
순위 매기기
Rank these aspects of nursing care from most to least important to you personally.
- Clear communication and listening
- Effective pain management
- Quick response to call button or requests
- Clear explanation of medications and procedures
- Emotional support and compassion
- Coordination between nurses and doctors
드래그하여 순위 지정
Q09
객관식
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
장문형
Is there anything a nurse did especially well, or anything they could improve, that we haven't asked about?
Q11
객관식
Which age range best describes you?
- Under 18
- 18-29
- 30-44
- 45-59
- 60-74
- 75 or older
- Prefer not to say
Q12
객관식
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
메시지
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.
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- 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 TemplateA 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.
잘하는 점
- 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
아쉬운 점
- 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 TemplateA 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.
잘하는 점
- 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
아쉬운 점
- 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
설문을 공개할 준비가 되셨나요?
이 템플릿을 편집기에서 열어 보세요. 첫 응답자가 보기 전에 모든 부분을 원하는 대로 바꿀 수 있습니다.